Form 84705-C - Account Closure Request
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1Complete this form for each account you are requesting to be closed. Make additional copies as needed.
Account Closure Request
Close the accounts at your former financial institution.
This account closure request allows you to specify the date you want
start using your new
your former account closed and where you want your remaining
union Bank accounts
balance sent.
exclusively.
three siMple steps
Today’s Date:
1
Name of Former Institution:
Complete this form.
Former Account Number:
2
Ensure your new Union Bank
account is active before you
Address:
close your existing account.
City, State, Zip Code:
3
Send this form to your former
institution after all your
Effective as of (Date):
existing checks, deposits,
direct deposits, automatic
You may choose to have funds from your former account wired or sent via cashier’s check.
payments, and pre-authorized
Select option A or B below.
transfers have cleared. Once all
A)
Close the account noted above and wire the balance and any interest accrued to:
these items have cleared, you’re
ready to close your former
Union Bank Account Information
account.
Union Bank Account Type:
Checking
Savings
Money Market
For assistance, call Union Bank
at 1-800-238-4486, Monday-Friday,
Union Bank Account Number:
from 7:00 a.m. to 9:00 p.m., and
Union Bank ABA Routing Number: 122000496
Saturday, from 8:00 a.m. to 5:00 p.m.
(Pacific Time).
B)
Close the account(s) noted above in the name of
and send a cashiers’s check for the remaining balance to the address below.
First Name:
note: Your former bank may
Last Name:
charge you a fee for fulfilling
this request.
Address:
City, State, Zip Code:
Phone Number:
(
) -
-
Primary Accountholder’s Signature
Date
Joint Accountholder’s Signature
Date
84705-C (12/11)
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Parent category: Business